Accelerating PrEP provision in primary care settings: Development and Testing of A Practice-Level Multifaceted Implementation Strategy

University Of Pennsylvania, Philadelphia PA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Substantial measures must be taken to improve HIV pre-exposure prophylaxis (PrEP) provision among African Americans across all geographic regions in the United States, which has been undermined by individual, interpersonal, and structural factors. Improving PrEP provision has become imperative as long-acting PrEP modalities emerge, and there is an urgent need to develop implementation strategies that support optimal PrEP service delivery. The goal of this K23 is to facilitate Dr. Watson’s long-term goal to become an independent investigator focused on the development of implementation strategies to achieve optimal HIV care continuum outcomes. The proposed K23 will focus on designing and pilot testing a multifaceted implementation strategy to improve PrEP provision for African American primary care patients, grounded in an adapted conceptual framework that includes constructs from the Consolidated Framework for Implementation Research (CFIR) and Bandura’s Social Cognitive Theory. Dr. Watson’s proposed research plan will consist of training objectives in (1) qualitative research, (2) behavioral and social science research, (3) community-engaged research, and (4) implementation science. With a focus on applications within implementation science, Dr. Watson requires further training in qualitative research, behavioral and social science research, and trial design to develop and pilot an implementation strategy to increase local PrEP provision capacity. These training objectives will be achieved through mentorship from an exemplary multidisciplinary mentorship team, complementary research aims, and professional development activities. Specifically, she plans to: (Aim 1) Identify modifiable provider-, practice-, and community-level CFIR-based determinants of local PrEP delivery; (Aim 2) Develop a theory-informed multifaceted implementation strategy to accelerate PrEP provision for African American primary care patients; (Aim 3) Conduct a 12-month two-arm pilot trial to evaluate strategy feasibility and acceptability at four medical practices that provide primary care services. The results of this study will be important for the field of implementation science as it focuses on facilitating theory-informed behavior changes among practice leadership and PrEP providers to support PrEP implementation in primary care settings. Findings from the pilot will inform the design and submission of an R01 application for a hybrid effectiveness-implementation trial of the implementation strategy. The proposal will form a strong foundation for Dr. Watson’s continued development toward an independently funded career as an implementation scientist invested in the development of implementation strategies to improve PrEP care outcomes in the U.S.